Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

INSERT PLEUAL CATH-LT

Facility

$17,259.20

Service Code	HCPCS 32550LT
Hospital Charge Code	2691060
Hospital Revenue Code	361
Min. Negotiated Rate	$2,588.88
Max. Negotiated Rate	$2,588.88
Rate for Payer: Qualcare PPO/HMO/WC	$2,588.88

INSERT PLEUAL CATH-LT

Facility

$17,259.20

Service Code	HCPCS 32550LT
Hospital Charge Code	321032550L
Hospital Revenue Code	361
Min. Negotiated Rate	$490.16
Max. Negotiated Rate	$8,629.60
Rate for Payer: Aetna Commercial	$6,558.50
Rate for Payer: Aetna Medicare Advantage	$5,177.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,401.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,401.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,401.10
Rate for Payer: Cigna Commercial	$8,629.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,487.39
Rate for Payer: Qualcare PPO/HMO/WC	$2,588.88
Rate for Payer: UnitedHealthcare Community & State	$545.39
Rate for Payer: Wellpoint Medicaid Managed Care	$490.16

INSERT PLEUAL CATH-LT

Facility

$17,259.20

Service Code	HCPCS 32550LT
Hospital Charge Code	321032550L
Hospital Revenue Code	361
Min. Negotiated Rate	$2,588.88
Max. Negotiated Rate	$2,588.88
Rate for Payer: Qualcare PPO/HMO/WC	$2,588.88

INSERT PLEUAL CATH-LT

Facility

$17,259.20

Service Code	HCPCS 32550LT
Hospital Charge Code	2691060
Hospital Revenue Code	361
Min. Negotiated Rate	$490.16
Max. Negotiated Rate	$8,629.60
Rate for Payer: Aetna Commercial	$6,558.50
Rate for Payer: Aetna Medicare Advantage	$5,177.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,401.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,401.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,401.10
Rate for Payer: Cigna Commercial	$8,629.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,487.39
Rate for Payer: Qualcare PPO/HMO/WC	$2,588.88
Rate for Payer: UnitedHealthcare Community & State	$545.39
Rate for Payer: Wellpoint Medicaid Managed Care	$490.16

INSERT PLEURAL CATH

Facility

$9,976.00

Service Code	HCPCS 32550
Hospital Charge Code	1600000689
Hospital Revenue Code	360
Min. Negotiated Rate	$283.32
Max. Negotiated Rate	$15,429.97
Rate for Payer: Aetna Commercial	$11,569.82
Rate for Payer: Aetna Medicare Advantage	$13,781.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,429.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,429.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,253.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,429.97
Rate for Payer: Cigna Commercial	$8,526.35
Rate for Payer: Cigna Medicare Advantage	$4,253.61
Rate for Payer: Clover Medicare Advantage	$4,040.93
Rate for Payer: EmblemHealth Commercial	$12,760.83
Rate for Payer: Humana Medicare Advantage	$4,381.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,253.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,593.76
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.40
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$315.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,253.61
Rate for Payer: Wellcare Medicare Advantage	$4,253.61
Rate for Payer: Wellpoint Medicaid Managed Care	$283.32

INSERT PLEURAL CATH

Facility

$9,976.00

Service Code	HCPCS 32550
Hospital Charge Code	1600000689
Hospital Revenue Code	360
Min. Negotiated Rate	$1,496.40
Max. Negotiated Rate	$1,496.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.40

INSERT POLYETHYLENE 10 DEGR 36

Facility

$4,836.25

Service Code	HCPCS C1776
Hospital Charge Code	270676582
Hospital Revenue Code	278
Min. Negotiated Rate	$137.35
Max. Negotiated Rate	$2,418.12
Rate for Payer: Aetna Commercial	$1,837.78
Rate for Payer: Aetna Medicare Advantage	$1,450.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,233.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,233.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$967.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,233.24
Rate for Payer: Cigna Commercial	$2,418.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,170.37
Rate for Payer: Qualcare PPO/HMO/WC	$725.44
Rate for Payer: UnitedHealthcare Community & State	$152.83
Rate for Payer: Wellpoint Medicaid Managed Care	$137.35

INSERT POLYETHYLENE 10 DEGR 36

Facility

$4,836.25

Service Code	HCPCS C1776
Hospital Charge Code	270676582
Hospital Revenue Code	278
Min. Negotiated Rate	$725.44
Max. Negotiated Rate	$1,170.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$967.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,170.37
Rate for Payer: Qualcare PPO/HMO/WC	$725.44

INSERT POLYETHYLENE 28MM SZ C

Facility

$5,694.75

Hospital Charge Code	270676687
Hospital Revenue Code	278
Min. Negotiated Rate	$161.73
Max. Negotiated Rate	$2,847.38
Rate for Payer: Aetna Commercial	$2,164.01
Rate for Payer: Aetna Medicare Advantage	$1,708.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,452.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,452.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,138.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,452.16
Rate for Payer: Cigna Commercial	$2,847.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,378.13
Rate for Payer: Qualcare PPO/HMO/WC	$854.21
Rate for Payer: UnitedHealthcare Community & State	$179.95
Rate for Payer: Wellpoint Medicaid Managed Care	$161.73

INSERT POLYETHYLENE 28MM SZ C

Facility

$5,694.75

Hospital Charge Code	270676687
Hospital Revenue Code	278
Min. Negotiated Rate	$854.21
Max. Negotiated Rate	$1,378.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,138.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,378.13
Rate for Payer: Qualcare PPO/HMO/WC	$854.21

INSERT POLYETHYLENE 32MM D

Facility

$8,225.75

Service Code	HCPCS C1776
Hospital Charge Code	270680444
Hospital Revenue Code	278
Min. Negotiated Rate	$1,233.86
Max. Negotiated Rate	$1,990.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,645.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,990.63
Rate for Payer: Qualcare PPO/HMO/WC	$1,233.86

INSERT POLYETHYLENE 32MM D

Facility

$8,225.75

Service Code	HCPCS C1776
Hospital Charge Code	270680444
Hospital Revenue Code	278
Min. Negotiated Rate	$233.61
Max. Negotiated Rate	$4,112.88
Rate for Payer: Aetna Commercial	$3,125.78
Rate for Payer: Aetna Medicare Advantage	$2,467.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,097.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,097.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,645.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,097.57
Rate for Payer: Cigna Commercial	$4,112.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,990.63
Rate for Payer: Qualcare PPO/HMO/WC	$1,233.86
Rate for Payer: UnitedHealthcare Community & State	$259.93
Rate for Payer: Wellpoint Medicaid Managed Care	$233.61

INSERT POLYETHYLENE 36MM E

Facility

$9,256.00

Service Code	HCPCS C1776
Hospital Charge Code	270679971
Hospital Revenue Code	278
Min. Negotiated Rate	$1,388.40
Max. Negotiated Rate	$2,239.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,851.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,239.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,388.40

INSERT POLYETHYLENE 36MM E

Facility

$9,256.00

Service Code	HCPCS C1776
Hospital Charge Code	270679971
Hospital Revenue Code	278
Min. Negotiated Rate	$262.87
Max. Negotiated Rate	$4,628.00
Rate for Payer: Aetna Commercial	$3,517.28
Rate for Payer: Aetna Medicare Advantage	$2,776.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,360.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,360.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,851.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,360.28
Rate for Payer: Cigna Commercial	$4,628.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,239.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,388.40
Rate for Payer: UnitedHealthcare Community & State	$292.49
Rate for Payer: Wellpoint Medicaid Managed Care	$262.87

INSERT POLYETHYLENE 36MM F

Facility

$4,279.80

Service Code	HCPCS C1776
Hospital Charge Code	270677485
Hospital Revenue Code	278
Min. Negotiated Rate	$641.97
Max. Negotiated Rate	$1,035.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$855.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,035.71
Rate for Payer: Qualcare PPO/HMO/WC	$641.97

INSERT POLYETHYLENE 36MM F

Facility

$4,279.80

Service Code	HCPCS C1776
Hospital Charge Code	270677485
Hospital Revenue Code	278
Min. Negotiated Rate	$121.55
Max. Negotiated Rate	$2,139.90
Rate for Payer: Aetna Commercial	$1,626.32
Rate for Payer: Aetna Medicare Advantage	$1,283.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,091.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,091.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$855.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,091.35
Rate for Payer: Cigna Commercial	$2,139.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,035.71
Rate for Payer: Qualcare PPO/HMO/WC	$641.97
Rate for Payer: UnitedHealthcare Community & State	$135.24
Rate for Payer: Wellpoint Medicaid Managed Care	$121.55

INSERT POLYETHYLENE 36MM G

Facility

$9,256.00

Service Code	HCPCS C1776
Hospital Charge Code	270679922
Hospital Revenue Code	278
Min. Negotiated Rate	$262.87
Max. Negotiated Rate	$4,628.00
Rate for Payer: Aetna Commercial	$3,517.28
Rate for Payer: Aetna Medicare Advantage	$2,776.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,360.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,360.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,851.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,360.28
Rate for Payer: Cigna Commercial	$4,628.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,239.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,388.40
Rate for Payer: UnitedHealthcare Community & State	$292.49
Rate for Payer: Wellpoint Medicaid Managed Care	$262.87

INSERT POLYETHYLENE 36MM G

Facility

$9,256.00

Service Code	HCPCS C1776
Hospital Charge Code	270679922
Hospital Revenue Code	278
Min. Negotiated Rate	$1,388.40
Max. Negotiated Rate	$2,239.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,851.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,239.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,388.40

INSERT PROLONG TIBIAL SZ2 +0

Facility

$11,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270677294
Hospital Revenue Code	278
Min. Negotiated Rate	$1,687.50
Max. Negotiated Rate	$2,722.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,722.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,687.50

INSERT PROLONG TIBIAL SZ2 +0

Facility

$11,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270677294
Hospital Revenue Code	278
Min. Negotiated Rate	$319.50
Max. Negotiated Rate	$5,625.00
Rate for Payer: Aetna Commercial	$4,275.00
Rate for Payer: Aetna Medicare Advantage	$3,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,868.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,868.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,868.75
Rate for Payer: Cigna Commercial	$5,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,722.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,687.50
Rate for Payer: UnitedHealthcare Community & State	$355.50
Rate for Payer: Wellpoint Medicaid Managed Care	$319.50

INSERT P.S 17MM S3

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270681470
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

INSERT P.S 17MM S3

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270681470
Hospital Revenue Code	278
Min. Negotiated Rate	$127.80
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Community & State	$142.20
Rate for Payer: Wellpoint Medicaid Managed Care	$127.80

INSERT P.S. 20MM S3

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270679716
Hospital Revenue Code	278
Min. Negotiated Rate	$127.80
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Community & State	$142.20
Rate for Payer: Wellpoint Medicaid Managed Care	$127.80

INSERT P.S. 20MM S3

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270679716
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

INSERT PSN RVCK ART SUR VE18MM

Facility

$12,905.00

Service Code	HCPCS C1776
Hospital Charge Code	270700044
Hospital Revenue Code	278
Min. Negotiated Rate	$366.50
Max. Negotiated Rate	$6,452.50
Rate for Payer: Aetna Commercial	$4,903.90
Rate for Payer: Aetna Medicare Advantage	$3,871.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,290.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,290.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,581.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,290.78
Rate for Payer: Cigna Commercial	$6,452.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,123.01
Rate for Payer: Qualcare PPO/HMO/WC	$1,935.75
Rate for Payer: UnitedHealthcare Community & State	$407.80
Rate for Payer: Wellpoint Medicaid Managed Care	$366.50

Know your out-of-pocket cost for care.

All Charges